PDF(Pubmed)
Abstract：
Spondylolysis with pseudarthrosis may be treated surgically by repairing the spondylolysis using the smiley face rod (SFR) technique. The SFR technique can avoid adjacent segmental disease caused by transforaminal lumbar interbody fusion (TLIF), which is one of the main surgical techniques to treat isthmic lumbar spondylolisthesis. A 59-year-old woman had been playing softball since she was 12 years old and was a member of a prefectural representative team. She sought treatment because of numbness in her left lower limb and difficulty playing softball. Despite conservative treatment for a year, her symptoms did not improve. Physical examination revealed decreased patellar tendon reflexes and numbness and pain from the front of the thigh to the lower leg without muscle weakness. Imaging showed L4 isthmic spondylolisthesis with Meyerding classification grade 2 anterior slip and L5 spondylolysis with pseudarthrosis. We diagnosed L4 radiculopathy caused by L4/5 foraminal stenosis and L4 isthmic spondylolisthesis with L5 spondylolysis. She underwent surgery combining the TLIF of L4/5 and the SFR technique of L5 using dual-headed pedicle screws that can fix two types of rods with L5 pedicle screws. Three months after surgery, fusion between L4/5 and fusion of the L5 pars cleft were confirmed. She resumed sports, and one year postoperatively, she was able to participate in softball games. Two years postoperatively, she could bat, run, and play defense without adjacent segmental disease. Two-segment TLIF increases adjacent segmental disease more than single-segment TLIF. Because the L5 spondylolysis had not slipped, we chose the SFR technique to preserve mobility at L5/S1. The dual-headed pedicle screw fastens two-type rods at the head of the pedicle screw, making it a suitable design for this procedure.
摘要：
可以通过使用笑脸棒（SFR）技术修复脊椎溶解来手术治疗假关节的脊椎溶解。SFR技术可以避免经椎间孔腰椎椎间融合术(TLIF)引起的邻近节段性疾病,是治疗峡部裂性腰椎滑脱的主要手术技术之一。一名59岁的妇女从12岁起就开始打垒球，是县代表队的成员。由于左下肢麻木和打垒球困难，她寻求治疗。尽管保守治疗了一年，她的症状没有改善。体格检查显示，从大腿前部到小腿，髌腱反射减少，麻木和疼痛，没有肌肉无力。影像学显示L4峡部裂性腰椎滑脱，Meyerding分类为2级前滑脱，L5峡部裂伴假关节。我们诊断为L4/5椎间孔狭窄引起的L4神经根病和L4峡部滑脱伴L5峡部裂。她使用双头椎弓根螺钉进行了L4/5的TLIF和L5的SFR技术相结合的手术，该螺钉可以用L5椎弓根螺钉固定两种类型的杆。手术三个月后,证实了L4/5之间的融合和L5裂的融合。她恢复了运动,术后一年，她能够参加垒球比赛。术后两年,她可以击球，run,并在没有相邻节段疾病的情况下进行防御。两部分TLIF比单部分TLIF增加相邻部分疾病。因为L5峡部裂没有滑倒,我们选择SFR技术来保持L5/S1的迁移率。双头椎弓根螺钉将双杆固定在椎弓根螺钉的头部，使它成为这个程序的合适设计。
